Abstract
ObjectivesRadiocephalic arteriovenous fistulas (RCAVF) are the preferred vascular access (VA) for hemodialysis (HD). Cohort studies from North America revealed that nonmaturation is a significant disadvantage of RCAVFs compared to other VAs. DESIGN: This present retrospective study describes the incidence of nonmaturation of AVFs and functional failure of arteriovenous grafts (AVG) in a multicentre cohort in the Netherlands and attempts to create a prediction model for nonmaturation of RCAVFs. Furthermore, the efficacy of interventions to promote maturation as well as the variability between hemodialysis centers was evaluated.MaterialsMedical records from 8 hospitals from 1997 to 2016 were retrospectively evaluated for VA type, maturation/primary success and demographics and comorbidities.MethodsA prediction model was created for RCAVF nonmaturation using multivariate logistic regression analysis, selecting significant predictors using backward selection. Discrimination and calibration of the model were assessed.Results1383 AVFs and 273 AVGs were included in 1221 patients. Overall nonmaturation was 24% for RCAVFs, and 11% for upper arm AVFs. The functional failure rate for AVGs was 6%. The nonmaturation rate of contralateral RCAVFs after failure of an RCAVF was 22%. Procedures to improve RCAVF maturation were successful in 98/142 cases (69%). Predictors for nonmaturation were female gender, peripheral vascular disease, cerebrovascular disease and a cephalic vein diameter <2.5 mm, but the prediction model lacked sensitivity and specificity predicting individual RCAVF nonmaturation (C-statistic 0.629).ConclusionNonmaturation rates are highest for RCAVFs, but nonmaturation could not be predicted with demographic parameters.
Highlights
The arteriovenous fistula (AVF) is the preferred type of permanent vascular access (VA) in maintenance hemodialysis (HD) patients
Cohort studies from North America revealed that nonmaturation is a significant disadvantage of Radiocephalic arteriovenous fistulas (RCAVF) compared to other VAs
DESIGN: This present retrospective study describes the incidence of nonmaturation of AVFs and functional failure of arteriovenous grafts (AVG) in a multicentre cohort in the Netherlands and attempts to create a prediction model for nonmaturation of RCAVFs
Summary
The arteriovenous fistula (AVF) is the preferred type of permanent vascular access (VA) in maintenance hemodialysis (HD) patients. Healthcare costs are lowest for patients with an AVF, compared to patients with an AVG or CVC [1]. Both the NKF KDOQI and EBPG guidelines advocate the creation of AVFs distally in the upper extremity whenever possible [1, 2]. RCAVFs are associated with a lower incidence of HD access-induced distal ischemia [3], when compared to upper arm AVFs. High flow predisposes to increased cardiac output and impaired systemic blood flow in patients with impaired cardiac function, a phenomenon known as ‘AVF cardiotoxicity’ [4, 5]
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